Provider Demographics
NPI:1770197535
Name:SHILING, GENNADY (RN)
Entity Type:Individual
Prefix:
First Name:GENNADY
Middle Name:
Last Name:SHILING
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:SHILING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:22699 E IDA CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-6669
Mailing Address - Country:US
Mailing Address - Phone:303-507-3623
Mailing Address - Fax:
Practice Address - Street 1:206 UVALDA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-8602
Practice Address - Country:US
Practice Address - Phone:303-551-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0169522163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)